Risk factors for IOP spike post-cataract surgery

This retrospective study found that longer axial length, previous trabeculoplasty, high use of glaucoma medication and non-use of oral acetazolamide were associated with a higher risk of IOP spikes after cataract surgery in glaucoma patients.

The authors reviewed the records of 271 consecutive glaucoma patients (271 eyes) without previous incisional glaucoma surgery who underwent phacoemulsification with the same surgeon between August 1996 and July 2012.

Forty-five patients (17 percent) had an IOP spike, defined as an IOP greater than 50 percent above baseline. Risk factors for postoperative IOP spike by multivariate analysis included longer axial length or associated characteristics (wider angle grade on gonioscopy, deeper anterior chamber and male sex), high number of preoperative IOP-lowering medications, previous laser trabeculoplasty and not taking postoperative oral acetazolamide.

The only modifiable risk factor for postop IOP spike was the use of oral acetazolamide as part of the postop regimen.

They conclude that patients requiring a higher number of IOP-lowering medications or laser trabeculoplasty for IOP control preoperatively and those with a greater axial length should be treated more aggressively with IOP-lowering medication during the immediate postoperative period.